Bacteriological quality of community well water and public health concerns in Enugu urban, Nigeria

Background: Water is a basic necessity used by humans for both domestic and industrial uses. Next to air, water is essential to life. It takes up about 71% of the earth’s surface. The objective of this study is to determine the bacteriological quality of well water in Enugu urban, Nigeria Methodology: A total of 60 domestic wells were selected from Abakpa, Obiagu and Achara layouts in Engu urban, Nigeria by stratified random sampling method, with 20 wells selected from each area based on location of well sites and construction parameters. Water samples were collected from each well using a sterile 200ml plastic bottle for bacteriological analysis to estimate total bacteria count in colony forming unit (cfu)/ml, total coliform count in most probable number (mpn)/100ml, and faecal coliform count in most probable number (mpn)/100ml. Bacterial isolates were identified using Gram reaction and conventional biochemical tests including catalase and coagulase for Gram positive bacteria, and oxidase, citrate utilization, hydrogen sulfide, indole, urease, methyl red, Voges Proskauer, and sugar fermentation tests for Gram negative bacteria. Antibiotic susceptibility testing (AST) of each isolate was performed by the disk diffusion method against selected antibiotics including penicillin G (10µg), ciprofloxacin (5µg), streptomycin (10µg), amoxicillin-clavulanic acid (20/10µg), and trimethoprim-sulfamethoxazole (25µg), and result interpreted using the European Committee for Antimicrobial Susceptibility Testing (EUCAST) break points. Comparative statistics of the data was performed using analysis of variance (ANOVA) with p<0.05 considered statistically significant. Results: The well water in the three layouts were heavily contaminated as shown by comparatively high mean total bacteria counts of 0.8825±0.66x104 cfu/ml, 0.8435±0.6413x104 cfu/ml, and 0.8384±0.5948x104 cfu/ml for Abakpa, Obiagu and Achara layouts respectively (p=0.9714). The mean total coliform counts were 5.15±5.284, 5.45±4.31 and 5.05±4.763 mpn/100ml (p=0.8038), and the mean faecal coliform counts were 2.4±3.393, 2.65±2.796 and 2.05±2.35 mpn/100ml (p=0.9631) for Abakpa, Obiagu and Achara layouts respectively. A total of 50 pathogenic bacterial isolates were identified; Klebsiella pneumoniae 21 (43.8%), Escherichia coli 13 (30.0%), Proteus spp 6 (12.5%), Pseudomonas aeruginosa 6 (12.5%), and Staphylococcus aureus 2 (4.2%). The AST result shows that 75% of K. pneumoniae, E. coli, Proteus spp and S. aureus were resistant to all five antibiotics tested. Conclusion: These findings showed high faecal contamination of domestic well water sources, which poses a significant infection risk to the community. Proper water treatment measures and personal hygiene practices are recommended, and well sites should be located at a safe distance from septic tanks, pit latrines, flowing gutters and refuse dump sites

Desire to practice postpartum contraception among antenatal women at Awka, Southeast Nigeria

Background: Postpartum contraception enables the nursing woman recover from the effects of pregnancy and childbirth before embarking on another pregnancy. It also promotes child welfare. The assessment of the desire by pregnant women to take up postpartum contraceptive service will help the planning of good delivery of this service.Methods: A cross-sectional study of antenatal clinic attendees at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Awka was done using a pretested interviewer-administered questionnaire. Data was analyzed with IBM SPSS version 20 software and associations between variables were tested with Chi square. Level of significance was set at P ≤0.05.Results: A total of 262 antenatal women were interviewed. The mean age of the respondents was 29.1±6.1 years while the mean parity was 2.5±1.5. Two hundred and one of the study women (76.7%) had the desire to practice postpartum contraception after the index pregnancy while only 9 (3.4%) were unsure whether they had the desire or not. Multiparous women are more likely to desire postpartum contraception (P <0.01). Also, previous use of contraception (P<0.01), desired index pregnancy (P=0.01) and being married or single (P=0.02) are all significantly associated with the desire to practice postpartum contraception.Conclusions: There was a high level of desire to practice postpartum contraception among antenatal clinic attendees at Awka. Parity, marital status, desired index pregnancy and previous practice of contraception all influence this desire

Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

INTRODUCTION: We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery. MATERIALS AND METHODS: We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant. RESULTS: Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001). CONCLUSIONS: Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section

Contribution of indirect obstetric deaths to maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Nnewi.

Introduction: Maternal death is unacceptably high in this center like in most centers in the developing world.Objective: To determine the maternal mortality ratio and the contribution of the direct and indirect obstetric complications to maternal deaths.Method: A retrospective review of all maternal deaths at Nnamdi Azikiwe University Teaching Hospital Nnewi, between January, 2003 andDecember 2007, a 5 year period. Maternal deaths, were identified from the labour ward, lying-in ward, sick prenatal ward, postnatal ward,gynaecology ward records and the medical records. The total number of births was gotten from the labour ward register.Results: There were 36 maternal deaths within the study period, and maternal mortality ratio of 1282 per 100,000 deliveries. The majority(64%) were due to indirect causes. The most common cause was pulmonary tuberculosis (25%). Anaemia contributed 14% and, viral hepatitis 11%. Cerebral malaria, intestinal obstruction and metastatic breast cancer caused 2.8% of maternal deaths each. The direct obstetrics causes contributed 36%, with preclampsia/eclampsia 19.4%, sepsis (Septic abortion and puerperal Sepsis) 8.4%, haemorrhage 5.6% and uterine rupture 2.8%.Conclusion: Indirect obstetric causes accounted for majority of the maternal deaths recorded within the study period

Perception of labour pain and desire for pain relief in labour among parturients in a tertiary health facility in south-eastern Nigeria

Background: There are varied perceptions about pain and its relief in labour among pregnant women in Africa.Objectives: This study aims to assess the perception of labour pain among parturients in a tertiary health institution in Nigeria. It also assessed the women’s awareness of and desire for labour analgesia.Methodology: One thousand, one hundred (1100) consecutive women who delivered at a University Teaching Hospital were studied using pretested researcher administered questionnaires. Data were entered into and analysed with SPSS 21. Statistical tests were done with Chi- square and T- test as appropriate. P-value of less than 0.05 was considered significant.Result: The mean age of the respondents was 29.2 + 5.89 while the mean parity was 2.43 + 1.59. One thousand and ninety respondents (99.1%) reported that labour was painful and majority (91.3%) of them graded pain as severe. The mean pain score was 85.1 + 16.2. Having antenatal care, partner support, attendance to antenatal classes, delivery by emergency C-section and induced labour were significantly associated with identifying labour as painful. Awareness of labour analgesia was poor as only 39.5% of the respondents reported so and only 1.4% of the parturients requested pain relief.Conclusion: The women generally reported labour as being very painful, yet they had poor knowledge of, and demand for labour analgesia. This poor knowledge exists despite the fact that majority of these women had antenatal care, suggesting that health information given to them may be deficient. Misconceptions were the main reasons for not requesting pain relief in labour.Keywords: Labour analgesia, Labour pain, Knowledge, Acceptanc

Desire to practice postpartum contraception among antenatal women at Awka, Southeast Nigeria

Background: Postpartum contraception enables the nursing woman recover from the effects of pregnancy and childbirth before embarking on another pregnancy. It also promotes child welfare. The assessment of the desire by pregnant women to take up postpartum contraceptive service will help the planning of good delivery of this service.Methods: A cross-sectional study of antenatal clinic attendees at Chukwuemeka Odumegwu Ojukwu Teaching Hospital, Awka was done using a pretested interviewer-administered questionnaire. Data was analyzed with IBM SPSS version 20 software and associations between variables were tested with Chi square. Level of significance was set at P ≤0.05.Results: A total of 262 antenatal women were interviewed. The mean age of the respondents was 29.1±6.1 years while the mean parity was 2.5±1.5. Two hundred and one of the study women (76.7%) had the desire to practice postpartum contraception after the index pregnancy while only 9 (3.4%) were unsure whether they had the desire or not. Multiparous women are more likely to desire postpartum contraception (P &lt;0.01). Also, previous use of contraception (P&lt;0.01), desired index pregnancy (P=0.01) and being married or single (P=0.02) are all significantly associated with the desire to practice postpartum contraception.Conclusions: There was a high level of desire to practice postpartum contraception among antenatal clinic attendees at Awka. Parity, marital status, desired index pregnancy and previous practice of contraception all influence this desire